Esophageal reflux gastroesophageal

Reflux esophagitis or gastroesophageal reflux disease (GERD) most often results from incomplete closure, increased acid production, and most probably both. Variations in contour of the stomach serve the function of permitting expansion for meals and providing greater surface area for the further breakdown of the chyme, or products of digestion. 

XANTHINE DERIVATIVES. The patient taking theophylline may report heartburn because the drug relaxes the lower esophageal sphincter, allowing gastroesophageal reflux. Heartburn is minimized if the patient remains in an upright position and sleeps with the head of die bed elevated. 

The pathophysiology of GERD is a complex process. It is difficult to determine which occurs first gastroesophageal reflux leading to defective peristalsis with delayed clearing, or an incompetent lower esophageal sphincter pressure leading... 

Gastroesophageal reflux occurs in approximately 18% of infants. As in adults, transient lower esophageal sphincter relaxations appear to be the most common cause of GERD.26 This is due to developmental immaturity of the lower esophageal sphincter.27 Other causes include impaired luminal clearance of gastric acid, neurologic impairment, and type of infant formula. 

GERD gastroesophageal reflux disease H2RA histamine2-receptor antagonist LES lower esophageal sphincter... 

Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999 340 825-831. 

M.D. Crowell, A.G. Decker, V.A. Schettler, M.M. Moirano, H.J. Kim, and V.K. Sharma, Continuous 48-hr esophageal pH-metry in obese patients with gastroesophageal reflux symptoms compared to non-obese patients. Am. J. Gastroenterol. 100, S9-S23 (2005). 

In some cases, gastroesophageal reflux is associated with defective lower esophageal sphincter (LES) pressure or function. Patients may have decreased LES pressures related to spontaneous transient LES relaxations, transient increases in intraabdominal pressure, or an atonic LES. A variety of foods and medications may decrease LES pressure (Table 24-1). 

Johnson DA and Fennerty MB (2004) Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology 126(3) 660-664 Jonsson R, Sixt E, Landahl S et al. (2004) Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res 14(1) 47-52... 

Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole, are commonly prescribed to treat symptoms of heartburn, acid reflux, chest pain, dyspepsia, and chronic cough. PPIs inhibit the transfer of protons into the stomach lumen. Pharmacological acid suppression is thus used to treat gastroesophageal reflux disease (GERD) and esophagitis, peptic ulcers, and Helicobacter pylori infection as well as to prevent ulcer development with concurrent nonsteroidal anti-inflammatory drug use. 

These studies were generally carried out at bile-acid concentrations that occur naturally in humans e.g. for colon cells, after a high-fat meal for esophageal cells, in individuals with repeated heartburn due to duodeno-gastroesophageal reflux or in cholestatic liver disorders). Taken together, these studies indicate that induction of apoptosis by bile acid is likely a frequent challenge for cells throughout the GI tract. 

Use the ER tablets and transdermal system with caution in patients who have gastroesophageal reflux or who are concurrently taking drugs (such as bisphosphonates) that can cause or exacerbate esophagitis. 

Gastroesophageal reflux disease (GERD) (including erosive esophagitis)... 

Symptomatic gastroesophageal reflux 10 to 15 mg orally up to 4 times daily 30 minutes before each meal and at bedtime. If symptoms occur only intermittently or at specific times of the day, single doses up to 20 mg prior to the provoking situation may be preferred rather than continuous treatment. Occasionally, patients who are more sensitive to the therapeutic or adverse effects of metoclopramide (eg, elderly) will require only 5 mg/dose. Guide therapy directed at esophageal lesions by endoscopy. Therapy longer than 12 weeks has not been evaluated and cannot be recommended. 

Acute treatment of duodenal and gastric ulcers PO 40 mg/day at bedtime Duodenal ulcer maintenance PO 20 mg/day at bedtime Gastroesophageal reflux disease PO 20 mg twice a day Esophagitis PO 2-40 mg twice a day. 

Unlabeled Uses CHF, dysphagia, pain relief, relief of esophageal spasm with gastroesophageal reflux... 

Erosive esophagitis, poorly responsive gastroesophageal reflux disease, active duodenal ulcer, prevention and treatment of NSMD-induced ulcers PO 20 mg/day To maintain healing of erosive esophagitis PO 20 mg/day. 

Short-term treatment of symptomatic gastroesophageal reflux disease—15 mg once daily for up to 8 weeks Short-term treatment of erosive esophagitis—30 mg once daily for up to 8 to 16 weeks... 

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